The intensity of the conflict in the North Kivu Province in the Democratic Republic of Congo (DRC) has had its ebbs-and-flows since it exploded 24 years ago. “Children here can identify the distant sound of a Kalashnikov, a rocket or an AK47 just as easily as they distinguish a goat’s bleat from a cow’s moo”, says André Tshimanga, Médecins Sans Frontières’ assistant field coordinator. Nonetheless, the overwhelming majority of patients in Médecins Sans Frontières’ hospital in Masisi are not combatants, but mothers and their babies. In many poor societies women are pressured to bear many children who will help tend the field and take care of their parents at old age. But in a context of war, a family doesn’t only need hands to produce food: it also needs bodies to protect its land.
In the Great Lakes region, high population mobility throughout the 20th century deeply modified the balance between the different populations and ethnicity. In 1993 ongoing conflict in neighboring Burundi and Rwanda spilled over to the Congolese Kivu, and since then the ethnic background of the people – mostly Hutu, Tutsi, Hunde – has become one of the factors of continued conflict. About 70 armed groups are active in a region twice the size of Belgium, and the dynamics of conflict change incessantly: it depends on morphing alliances based on ethnic differences but also political ones, and disputes over land or mines. In this context, women’s bellies are a weapon among others.
"In many poor societies women are pressured to bear many children who will help tend the field and take care of their parents at old age. But in a context of war, a family doesn’t only need hands to produce food: it also needs bodies to protect its land."
Giving life to so many infants poses a direct threat to the mother’s health. Having births so close together increases the chance of losing the baby, tearing the uterus, and increases the likelihood to need a C-section. Last year we treated close to 5,000 children for severe malnutrition in Masisi, a condition that represents 42% of admissions in the emergency room. “As mothers give birth less than 2 years apart, they tend to stop breastfeeding early, with the older child coincidently receives an unbalanced diet”, Zachary Moluh, Médecins Sans Frontières’ head nurse in Masisi explains. Indeed, 80 to 90% of the mothers of young patients in the malnutrition ward are pregnant, like 28 years old Kumuka, sitting with the youngest of her five children. She’s been living in a displaced-persons camp for years. Her husband has no work. They have no field and they have no income. “I don’t want to be like my aunt who is always praised for having 15 children. I couldn’t support them; look, this one is sick already! Now that I heard of family planning here, I’ll try talking to my husband”, she says. Pregnant 28 years old Sarah, sitting in the next bed with her 18 month old child, is more forthcoming. “This will be my last child. I work in the field every day, from 6am to nighttime, and I can’t take care of them during this time. Six is not that many, but it’s enough.”
Next door, a group of a dozen mothers’ counsellors are trained on how to give information and advice on family planning to the women of their villages. They’re not directly advocating for having less children – this is a very sensitive topic culturally, especially in a war context – but list the benefits of at least spacing births. “If you have less little children you can better feed them all”, says the other. “And send them to school so that they can take better care of you later on”, adds another. When the past is chaos and the future muddy, spacing births may not seem like a priority, even though it is for the women’s bodies. “A woman is like a pagne (piece of cloth)”, says one of the mother counsellors. “If it’s used too much, it frays.” The women know; now they need to convince the men too.